| NPI | 1790923175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 004023) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 012413-1) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-02-24 |